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Palliative procedures for non-small cell lung cancer

Palliative, or supportive care, is aimed at relieving suffering and improving quality of life.

People with lung cancer often benefit from procedures aimed at helping with problems caused by the cancer. For example, people with advanced lung cancer can have problems with shortness of breath. This can be caused by a number of things, including fluid around the lung or an airway blockage. Although treating the cancer with chemotherapy may help with this over time, other treatments may be needed as well.

Treating fluid buildup in the area around the lungs

Sometimes fluid can build up in the chest outside of the lungs (called a pleural effusion). It can press on the lungs and cause trouble breathing.

Thoracentesis

This is done to drain the fluid. A doctor will numb an area in the chest, and then place a needle into the space between the lungs and the ribs and drain the fluid. This is often done using ultrasound to guide the needle into the area of fluid buildup.

Pleurodesis

A pleurodesis might be done to remove the fluid and keep it from coming back.

One way to do this is to make a small cut in the skin of the chest wall, and place a hollow tube (called a chest tube) into the chest to remove the fluid. Then a substance is instilled into the chest cavity through the tube that causes the linings of the lung (visceral pleura) and chest wall (parietal pleura) to become irritated. This causes the linings to stick together, sealing the space and limiting further fluid buildup. The tube is often left in for a couple of days to drain any new fluid that might collect. A number of things can be placed through the tube to irritate the linings, such as talc, the antibiotic doxycycline, or a chemotherapy drug like bleomycin.

Another way to do this is to blow talc into the space around the lungs (the pleural space) during an operation. This is done through a small incision using thoracoscopy.

Catheter placement

This is another way to control the buildup of fluid. One end of the catheter (a thin, flexible tube) is placed in the chest through a small cut in the skin, and the other end is left outside the body. This is done in a doctor’s office or hospital. Once in place, the catheter can be attached to a special bottle or other device to allow the fluid to drain out on a regular basis.

Treating fluid buildup around the heart

Lung cancer can sometimes spread to the area around the heart. This can lead to fluid buildup (a pericardial effusion) that presses on the heart so that it doesn’t work well.

Pericardiocentesis

In this procedure, the fluid is drained with a needle placed into the space around the heart. This is usually done using an echocardiogram (like an ultrasound of the heart), to guide the needle.

Pericardial window

This is done to keep the fluid from building up again. In an operation, a piece of the tissue around the heart (the pericardium) is removed to allow the fluid to drain into the chest or belly.

Treating airway blockage

If the cancer is growing into an airway in the lung, it can block the airway and cause problems like pneumonia or shortness of breath. Treatments can be used to relieve the blockage in the airway.

Photodynamic therapy (PDT)

Photodynamic therapy is sometimes used to treat very early stage lung cancers that are still confined to the outer layers of the lung airways when other treatments aren’t appropriate. It can also be used to help open up airways blocked by tumors to help people breathe better.

For this technique, a light-activated drug called porfimer sodium (Photofrin®) is injected into a vein. This drug is more likely to collect in cancer cells than in normal cells. After a couple of days (to give the drug time to build up in the cancer cells), a bronchoscope is passed down the throat and into the lung. This may be done with either local anesthesia (where the throat is numbed) and sedation or with general anesthesia (where you are in a deep sleep). A special laser light on the end of the bronchoscope is aimed at the tumor, which activates the drug and causes the cells to die. The dead cells are then removed a few days later during a bronchoscopy. This process can be repeated if needed.

PDT may cause swelling in the airway for a few days, which may lead to some shortness of breath, as well as coughing up blood or thick mucus. Some of this drug also collects in normal cells in the body, such as skin and eye cells. This can make you very sensitive to sunlight or strong indoor lights. Too much exposure can cause serious skin reactions (like a severe sunburn), so doctors recommend staying out of any strong light for 4 to 6 weeks after the injection.

Lasers can sometimes be used to treat very small tumors in the linings of airways. They can also be used to help open up airways blocked by larger tumors to help people breathe better.

You are usually asleep (under general anesthesia) for this type of treatment. The laser is on the end of a bronchoscope, which is passed down the throat and next to the tumor. The doctor then aims the laser beam at the tumor to burn it away. This treatment can usually be repeated, if needed.

Stent placement

Lung tumors that have grown into an airway can sometimes cause trouble breathing or other problems. To help keep the airway open (often after other treatments such as PDT or laser therapy), a hard silicone or metal tube called a stent may be placed in the airway using a bronchoscope.